I wanted to get other’s opinions on the much debatable issue of diagnostic versus preventative colonoscopy in my office. I have several providers within my office that like to order "screening" colonoscopies for the below scenarios.

1. Pt says they are here for a screening colon, first colon ever, but in the medical record physician documents symptomatic issues of constipation, rectal bleeding, diarrhea, etc. My provider feels that since the patient has not had a screening colon that they can order the procedure as such. I advise the provider that since the patient presented with symptoms then it is not a screening, per several articles I have found on the web from AAPC. How many other coders/billers have come across this issue and how did you handle this situation?

2. Patient comes in for screening colonoscopy. Provider documents that patient has "stable" chronic constipation. How would you code? In my opinion, patient has an issue and thus would be diagnostic, but the providers states that since it is stable it can be coded as a screening. Opinions?

Thank you all for your thoughts and opinions.